Congratulations Rob Orman on a fantastic job of hosting EMRAP!!!
Rob... Despite the obvious "pull"- please don't ever get an academic job. The fact that you are a real doctor who actually sees patients for a living gives you an aweful amount of street cred on the podcast circuit. I listen to your insights knowing that you are actually getting your hands dirty while juggling a busy patient load. This is without the backup of a tertiary center where only a minority of ER docs work. Your advice and education is very practical. Keep up the good work!
The Peds cardiology talk was the most useful lecture I've listened to in the last year. Some Emrap lectures don't seem to be entirely relevant to my day to day practice in the community hospital setting but this talk on REALLY sick and scary kids will help me sleep at night with knowing what to do once I've cleaned out my shorts. Thanks.
This peds section was one of the best sections in EMRAP's history for me. You took a topic that while rare, is very real and very nerve wracking to those of us who work in community hospitals at night. This section gave me concrete steps to follow that are simple despite complex physiology. Even though I have the luxury of a PICU in my hospital, it is not uncommon for someone to burst into triage with a critically ill infant in their arms, no warning, and everyone goes bezerk. There is always a period of time between that presentation and the arrival of our PICU doc when we need to act and this section makes me feel that much better about it. -Andrew Wittenberg, Long Beach, CA
Great Job Dr. Orman!!! I enjoyed this issue very much. This issue, as always, was loaded with practical information that can be used every day. I love the variety of topics covered in EMRap....Mel always seems to know what is eating away at the back of my brain!
I'm one of the Ivory Tower Academicians, and I have heard many Neonatal Cardiology lectures. However, this was, hands down, the best Neonatal Cardiology lecture that I have ever heard. Thank you.
Excellent job, one of your finest. Just a couple of things.... On the VW lecture, your guest mentioned this is a common disease and did a great job discussing treatment. Missing was guidance on setting thresh holds for testing, when to test, and how to test. Glad to see that Lidocaine wasn't banned by the AHA in your VT lecture. AM has mentioned this in other lectures but remind listeners that responsiveness to Adenosine doesn't make it SVT with aberrancy. I liked hearing expert opinion, but would like to see current data on effectiveness of various drugs. Sounds like they're all 1/3 effective. I use half life in my considerations. Lidocaine and safety net (IV/Defibrillator, prepared to shock) while the nurses find procainamine and sedation drugs and figure out how to administer. I use Amiodarone rarely since it lasts days, and may interfere with subsequent b blocker (plus I remember the early days of pulmonary fibrosis and blue skin). Occasionally have found that rapid administration of benzo AFTER shock for an unstable patient aborts memory formation although obviously not a preferred style point. Great Peds Ductal dependency lecture, even with a slightly arrogant and dismissive treatment of us dumb ED docs. Good organized approach. Would like to see f/u on whether afterload in these Stage I surgeries with pulmonary shunt can be managed mechanically vs. phenylephrine(are MAST trousers really dead ; ) ) and when should TPA be given for presumed shunt occlusion as death seems to be the only other option.
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Episode 144Full episode audio for MD edition228:29 min - 108 MB - M4AResumen del EM:RAP Septiembre 2013Español75:04 min - 52 MB - MP3EM:RAP 2013 September MP3291 MB - ZIPEM:RAP September 2013 Written Summmary819 KB - PDFEM:RAP September 2013 Board Review Questions630 KB - PDFEM:RAP September 2013 Board Review Answers630 KB - PDF
Brian D. - September 14, 2013 8:03 PM
Congratulations Rob Orman on a fantastic job of hosting EMRAP!!!
Rob... Despite the obvious "pull"- please don't ever get an academic job. The fact that you are a real doctor who actually sees patients for a living gives you an aweful amount of street cred on the podcast circuit. I listen to your insights knowing that you are actually getting your hands dirty while juggling a busy patient load. This is without the backup of a tertiary center where only a minority of ER docs work. Your advice and education is very practical. Keep up the good work!
John F. - September 19, 2013 4:13 PM
The Peds cardiology talk was the most useful lecture I've listened to in the last year. Some Emrap lectures don't seem to be entirely relevant to my day to day practice in the community hospital setting but this talk on REALLY sick and scary kids will help me sleep at night with knowing what to do once I've cleaned out my shorts. Thanks.
mitch h. - September 26, 2013 7:57 PM
excellent PEDS edition. Well done.
Kelly P. - October 11, 2013 10:43 AM
I liked how Orman gave a brief synopsis of the entire issue.
AWitt., M.D. - October 11, 2013 11:29 AM
This peds section was one of the best sections in EMRAP's history for me.
You took a topic that while rare, is very real and very nerve wracking to those of us who work in community hospitals at night. This section gave me concrete steps to follow that are simple despite complex physiology. Even though I have the luxury of a PICU in my hospital, it is not uncommon for someone to burst into triage with a critically ill infant in their arms, no warning, and everyone goes bezerk. There is always a period of time between that presentation and the arrival of our PICU doc when we need to act and this section makes me feel that much better about it.
-Andrew Wittenberg, Long Beach, CA
James K. - October 22, 2013 8:44 AM
Great Job Dr. Orman!!! I enjoyed this issue very much. This issue, as always, was loaded with practical information that can be used every day. I love the variety of topics covered in EMRap....Mel always seems to know what is eating away at the back of my brain!
David F. - October 30, 2013 7:59 AM
I'm one of the Ivory Tower Academicians, and I have heard many Neonatal Cardiology lectures. However, this was, hands down, the best Neonatal Cardiology lecture that I have ever heard. Thank you.
David M. - December 15, 2013 7:30 PM
Excellent job, one of your finest. Just a couple of things.... On the VW lecture, your guest mentioned this is a common disease and did a great job discussing treatment. Missing was guidance on setting thresh holds for testing, when to test, and how to test. Glad to see that Lidocaine wasn't banned by the AHA in your VT lecture. AM has mentioned this in other lectures but remind listeners that responsiveness to Adenosine doesn't make it SVT with aberrancy. I liked hearing expert opinion, but would like to see current data on effectiveness of various drugs. Sounds like they're all 1/3 effective. I use half life in my considerations. Lidocaine and safety net (IV/Defibrillator, prepared to shock) while the nurses find procainamine and sedation drugs and figure out how to administer. I use Amiodarone rarely since it lasts days, and may interfere with subsequent b blocker (plus I remember the early days of pulmonary fibrosis and blue skin). Occasionally have found that rapid administration of benzo AFTER shock for an unstable patient aborts memory formation although obviously not a preferred style point. Great Peds Ductal dependency lecture, even with a slightly arrogant and dismissive treatment of us dumb ED docs. Good organized approach. Would like to see f/u on whether afterload in these Stage I surgeries with pulmonary shunt can be managed mechanically vs. phenylephrine(are MAST trousers really dead ; ) ) and when should TPA be given for presumed shunt occlusion as death seems to be the only other option.